三种不同代谢综合征诊断标准对辽阳市青少年人群诊断能力的比较

The prevalence of metabolic syndrome in adolescents according to 3 different diagnostic criteria

目的探讨不同的青少年代谢综合征（MetS）诊断标准的一致性和差异性。方法选取辽阳市920名11～16岁青少年学生（男生53．2％），进行人体测量和生化学检测，选取3种青少年代谢综合征诊断标准，即中华医学会儿科分会推荐的儿童青少年MetS诊断标准（中国标准），2007年国际糖尿病联盟（IDte）推荐的诊断标准（IDF标准）和2003年Cook等参照美国国家胆固醇教育计划制定的诊断标准（Cook标准），比较不同诊断标准下的青少年MetS患病率、临床特点、各异常组份检出率的差异以及不同诊断标准的一致性。结果Cook标准（16．2％）检出的辽阳市青少年MetS患病率显著高于中国标准（11．00％）和IDF标准（7．93％）：检出率最高的MetS组份在中国标准和IDF标准均为低高密度脂蛋白胆固醇（HDL—C），在Cook标准为高血压；3种标准检出率最低的组份均为高血糖。中国标准与IDF标准两者的诊断结果之间具有良好一致性（Kappa系数0．798～0．829，P〈0．01）；Cook标准与另外两种标准的诊断一致性较弱（Kappa系数0．465～0．789，P〈0．01）。与正常青少年相比，单纯符合Cook标准而不被其他两种诊断标准识别的青少年人群有明显异常的腰围、血压、血糖、血脂水平和胰岛素抵抗指数。结论3种诊断标准对辽阳市青少年MetS患病率的检出结果差别较大，其中Cook标准能识别更多具有胰岛素抵抗和心血管危险因素的青少年。

Objective To evaluate the differences and consistency of different diagnostic criteria for metabolic syndrome （MetS） in adolescents. Methods This cross-sectional study enrolled 920 healthy middle school students （ aged 11-16 years, 53.2% males）. All participants underwent anthropometric and biochemical examinations, and were diagnosed as MetS separately using criterion of the Pediatric Academy of Chinese Medical Association （ abbreviated as Chinese criterion ）, 2007 International Diabetes Federation criterion （ IDF criterion）, and Cook criterion based on the National Cholesterol Education Program - Adult Treatment Panel in 2003 （ Cook criterion）. Statistic analysis was used to compare the prevalence of MetS diagnosed and the individual MetS components detected by the different diagnostic criteria, and to evaluate the differences and consistency between the three criteria. Results The prevalence of MetS diagnosed with the Cook criterion （ 16.2% ） was significantly higher than that by the Chinese criterion（ l 1.0% ） and the IDF criterion. The most frequently detected components were low high-density with the Chinese criterion and IDF criterion, hypertension with the Cook criterion. The least frequently detected component was hyperglycemia with each criterion. The consistency was found stronger between the Chinese and IDF criteria （Kappa = 0. 798-0. 829, P 〈 0.01 ） , but weak between the Cook and the other two criteria （ Kappa = 0. 465-0. 789, P〈0.01 ）. The adolescents solely diagnosed as MetS patients by the Cook criterion but not the other two criteria had more central obesity, higher plasma glucose and lipid levels and HOMA insulin resistance index （ all P〈0.05 ）. Conclusion The prevalence of MetS and components diagnosed with the three criteria was evidently different. The Cook criterion may diagnose more adolescents with higher cardiovascular risks and insulin resistance.